Objective:To investigate the feasibility and advantages of 30°reverse trendelenburg combined with semi-prone position in single-port thoracoscopic surgery for lung cancer.Methods:This study is a prospective, randomized controlled trial. Between October 2022 and December 2023, patients with lung cancer who met the inclusion and exclusion criteria were prospectively enrolled at the Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University,and randomized using a simple randomization design to generate a random number table. Patients were allocated in a 1∶1 ratio to either the modified positioning group (30°reverse trendelenburg combined with semi-prone position) or the conventional positioning group (lateral decubitus position). Comparative analysis was performed on feasibility metrics including operative time, postoperative pain scores, surgeon and assistant fatigue levels, number of lymph nodes dissected, duration of postoperative chest tube drainage, and postoperative hospital stay. Inter-group comparisons were conducted using independent sample t-tests, χ2 tests or Kruskal-Wallis. Results:A total of 211 patients were included.The modified positioning group comprised 105 patients (58 males, 47 females) with an age of (56.2±10.3）years (range: 23 to 74 years). The conventional positioning group included 106 patients (55 males, 51 females) with an age of (57.8±11.7）years (range: 21 to 76 years). All patients underwent successful single-port thoracoscopic lung cancer surgery without severe perioperative complications. No statistically significant differences were observed between groups in operative time ((98±34) minutes vs. (114±36) minutes, t=-1.642, P=0.221), number of lymph nodes dissected (13.4±2.5 vs. 12.8±3.2, t=0.702, P=0.763), postoperative chest tube duration ((4.3±1.5) days vs. (5.1±1.8) days, t=-1.348, P=0.247), or postoperative hospital stay ((5.0±1.2) days vs. (5.6±1.5) days, t=-0.831, P=0.682). The modified positioning group demonstrated significantly lower postoperative day 1 pain scores on the visual analog scale (3.1±2.0 vs. 4.6±1.9, t=-4.321, P=0.027) and postoperative surgeon-reported fatigue scores (primary surgeon: 13.6±2.5 vs. 18.5±3.3, t=-6.963, P=0.002; assistant surgeon: 12.1±2.0 vs. 17.1±3.1, t=-6.133, P=0.003) compared with the conventional group, with all differences reaching statistical significance. Conclusions:The application of 30°reverse trendelenburg combined with semi-prone position during single-port thoracoscopic lung cancer surgery is both safe and feasible. Compared with the conventional lateral decubitus position, this modified positioning demonstrates significant advantages in reducing postoperative pain and alleviating surgical team fatigue (including both primary and assistant surgeons).

Objective:To investigate the feasibility and advantages of 30°reverse trendelenburg combined with semi-prone position in single-port thoracoscopic surgery for lung cancer.Methods:This study is a prospective, randomized controlled trial. Between October 2022 and December 2023, patients with lung cancer who met the inclusion and exclusion criteria were prospectively enrolled at the Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University,and randomized using a simple randomization design to generate a random number table. Patients were allocated in a 1∶1 ratio to either the modified positioning group (30°reverse trendelenburg combined with semi-prone position) or the conventional positioning group (lateral decubitus position). Comparative analysis was performed on feasibility metrics including operative time, postoperative pain scores, surgeon and assistant fatigue levels, number of lymph nodes dissected, duration of postoperative chest tube drainage, and postoperative hospital stay. Inter-group comparisons were conducted using independent sample t-tests, χ2 tests or Kruskal-Wallis. Results:A total of 211 patients were included.The modified positioning group comprised 105 patients (58 males, 47 females) with an age of (56.2±10.3）years (range: 23 to 74 years). The conventional positioning group included 106 patients (55 males, 51 females) with an age of (57.8±11.7）years (range: 21 to 76 years). All patients underwent successful single-port thoracoscopic lung cancer surgery without severe perioperative complications. No statistically significant differences were observed between groups in operative time ((98±34) minutes vs. (114±36) minutes, t=-1.642, P=0.221), number of lymph nodes dissected (13.4±2.5 vs. 12.8±3.2, t=0.702, P=0.763), postoperative chest tube duration ((4.3±1.5) days vs. (5.1±1.8) days, t=-1.348, P=0.247), or postoperative hospital stay ((5.0±1.2) days vs. (5.6±1.5) days, t=-0.831, P=0.682). The modified positioning group demonstrated significantly lower postoperative day 1 pain scores on the visual analog scale (3.1±2.0 vs. 4.6±1.9, t=-4.321, P=0.027) and postoperative surgeon-reported fatigue scores (primary surgeon: 13.6±2.5 vs. 18.5±3.3, t=-6.963, P=0.002; assistant surgeon: 12.1±2.0 vs. 17.1±3.1, t=-6.133, P=0.003) compared with the conventional group, with all differences reaching statistical significance. Conclusions:The application of 30°reverse trendelenburg combined with semi-prone position during single-port thoracoscopic lung cancer surgery is both safe and feasible. Compared with the conventional lateral decubitus position, this modified positioning demonstrates significant advantages in reducing postoperative pain and alleviating surgical team fatigue (including both primary and assistant surgeons).

BACKGROUNDChemoresistance is common among patients with esophageal squamous cell carcinoma (ESCC). We investigated the effect and mechanism of insulin on enhancing anticancer functions of cisplatin in human esophageal cancer cell line EC9706.

METHODSThe viability of EC9706 cells exposed to cisplatin was assessed using MTT assay. The times T1, when the number of living cells reached a plateau and T2, when the number of living cells reached a new plateau after the addition of insulin were found. T1 and T2 plateau cells were stained by Annexin V-FITC/PI and monodansylcadaverin (MDC). Fluorescent microscopy was used to observe the expression of apoptosis and autophagy intuitively. Apoptotic ratio and fluorescent intensity were analysed by flow cytometry (FCM) quantitatively. Western blotting analysis was used to estimate the protein expression levels of AKT, mTOR, PI3K, PTEN, autophage related indicator LC3-II and autophage related protein Beclin1 changes that occurred in the course of treatment.

RESULTSA larger number of typical autophagosomes were detected in EC9706 cells exposed to cisplatin. Insulin can increase the apoptosis induced by cisplatin. Apoptotic ratio of T1 plateau cells ((32.6 ± 4.3)%) is significantly less than T2 plateau ((47.5 ± 5.6)%). MDC fluorescent intensity at T1 plateau (104.9 ± 13.2) was significantly higher than intensity at T2 plateau (82.6 ± 10.3). After cotreatment with insulin, the expression level of LC3-II, Beclin1 and PTEN in T2 plateau cells were significantly downregulated, but AKT, mTOR and PI3K expressions significantly upregulated compared with T1 plateau.

CONCLUSIONSInsulin could enhance cisplatin-induced apoptosis in human esophageal squamous cell carcinoma EC9706 cells related to inhibition of autophagy. The activation of PI3K/Akt/mTOR signaling pathway induced by insulin resulted in the suppression of autophagy in EC9706 cells, which may be attributed to the anticancer effects of cisplatin.

Apoptosis ; drug effects ; Autophagy ; drug effects ; Carcinoma, Squamous Cell ; metabolism ; Cell Line, Tumor ; Cell Survival ; drug effects ; Cisplatin ; pharmacology ; Esophageal Neoplasms ; metabolism ; Humans ; Phosphatidylinositol 3-Kinases ; metabolism ; Proto-Oncogene Proteins c-akt ; metabolism ; Signal Transduction ; drug effects